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HomeMy WebLinkAbout0125 EMERALD LANE - Health n.5 �r TOWN OF BARNSTABLE LOCATION SEWAGE # I G VILLAGE c �� ► ' ASSESSOR'S MAP 6z LOT Q �; e INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 4/ NO. OF BEDROOMS � PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER W g Z&� f DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No k*_— 1 �4 i e a '/ THE COMMONWEALTH OF MASSACHUSETTS Ll�RB BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Diinpuuul Wurku Toustrnrtiun rumit Application is hereby made for a Permit to Construct ( ) or Repair (61-'an Individual Sewage Disposal System at: ... ----Locatio \ddr;,s •---•----------------------•-----•-----•--or Lot No. �Ow r Address fWI Installer Address UType of Building Size Lot............................Sq. feet t., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons_..._______________________- Showers ( ) — Cafeteria ( ) a' Other fixtures ..................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity__________-gallons Length---------------- Width________-_-...__ Diameter....------------ Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ P4 •--••-••••---••-------------••••--•••••---••-••---•--••--•-•-•••-•...-•------•---•-•-•••--••------••........... -------------------------- _.... •.... -......... ODescription of Soil........................................................................................................................................................................ x U W ••••-•-•••-•------------------------------------•••- --------...-_..__......-----------•-----••-••-- ------ -----------_---------------------------.._. U Nature of Repairs or Alterations—Answer when applicabl - .. . . . ---------------------------•--•---•------------------------------------•-------------------------------------------------------....._.......__. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance as been issued by the boa of health. Date Application Approved By ----------------- ,[.cis�,.�.- ............. -r�t .`{'� Application Disapproved for the following reasons- ----- -- ----------------------------------------- ----------------------------------------------- -------------- -------------------------------------------------------------------------------------------------------------------------- Permit No. ............. ..-...... 7-.D, Date 0 7 Ll I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE , pphratiun for Divjipu,�3ttl War1w Tomitrurtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair (4-�'an Individual Sewage Disposal System at: .------ A Locatio, \ddrrss or Lot No. ........... .is/��..� -a..... -,-_....- ..................... ........................................................ Owne� a� Address . ....� ............................................ j I-nstaller Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures -----------------------------------------------•--------------••-•......-•---._...----..---------•-------•-----•-•-•--•-------••••......••-•-----•--. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length________________ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I-__--_-__-._-_minutes per inch Depth of Test Pit.................... Depth to ground water........................ �Z4 Test Pit No. 2................minutes per inch Depth of Test Pit.--_-_-_________---- Depth to ground water........................ a -•------••-------------------•••-•••-••----------••-•-•---•.._...--••-•-----•......-•-•-••••................................................................ ODescription of Soil........................................................................................................................................................................ x U •--•••......-••--••••--•--•-----•••._.....•--••-----•-•••----•••................•-•--••••••------•--------••----•----•-••••-•-•••-•-----•-•--•--•••-•---•-•--•-•••---•-••••-••-••-••----.........•-••••. x --------------------------------------------•----•-. -•------------•---•-------...----••......•--•-- ---- U Nat; e of Repairs or Alterations—Answer when applicable .-V-- , +��-•- Agreement: C The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance.has been issued by the board of health. Signed ...... .... ........ .'... ....../ , ......rive.......-- Application Approved B 1 U ............................... ....... .........(..jam-...------- le Application Disapproved for the following reafonf: .......... ..................... .............................. ................................ ......................... ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -----------------Dace Permit No. ........1... CC�� LY ...... 7.-D------------------------ Issued ------- .--. ........ -- . . . ................. Dare 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE %Ertifi ate of VQ-11IIittylianve THIS IS TO CERT Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �' by .... // `--�j-- ..= .."L'' .................... . ------------------..................................................................................................... in mue. at .................. .. S-------- .----Y--,#"/............. -----------I.... ....... . .. .. ......--........... ................................... . .............. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ---------- dated ---------------_---------------------__---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ........U.... .... .. 1 ;a.../.----------_- - -- Inspector ------------------------- ' �-.•-.....__._.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH qq TOWN OF BARNSTABLE No....L. 1.-.L FEE._. �unutr�trtiun �rrntit Permission is hereby granted...... _ _..//X.................................................................... to Construct ( ) or Repair (z--)--an Individual Sewage Disposal System atNo.................. -••-------•-------•-----------•-•------------•--- ----------------•----------.-------------------------------------------------------------------------•----•----------•--- Street as shown on the application for Disposal Works Construction Permit No._ ___V2`Y�Z�2,Dated------ .-_4 ::�._'�.�.1..._.. I J Ci��/_- -------------- Board of Health DATE-------------------=----•-•-=--------•_:•--•-•.----------•- FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS FILI,, LOiCATION r SEWAGE PERMIT. NO. VILLAGE INSTALLER'S NAME & ADDRESS - B U I'L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED < 77 i A� 4 ��f v 1 , / 76 P ASSESSOR'S MAP N0. 4G PARCEL 0 L0CAT10N f-f-'°sue 6-f SEWAGE PERMIT NO. "O"c ©w►.a t. VILLAGE / % ,' FM Rla�v I A 14 fl F T'vnf,I' I f L`j INSTALLER'S NAME i ADDRESS e U I L D E R OR OWNER DATE PERMIT ISSUED D AT E COMPLIANCE ISSUED 'E. 3 �r0 /?0o. J �NJ� -FO ga g r g art, ,le 00 0 ' 000 i Sv Qy Fir--L p ova! ron 1 No...... `a`l:__. F>cs.... 5`.U�.�........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _..-... /��'�''►...._..-.0F........00d .: ...... .. .!.. ............................. Appliration -fur 43iupuual Works Tomitrurtion Vrrmft Application is hereby'made for a Permit to Construct (0 or Repair ( } an Individual Sewage Disposal System at: kq_C . ....--•�M 1?AA 1.n 1-A-H z ... .. - ! ....__ _.... .. U.! ....................................... Location-Address or Lot No. --- _ Owner Address a - S).A.1.f N................................................ ..........................$a_M..k----...---------------------------------------------------- Installer Address Q Type of Building C A PC Size --------Sq. feet U — Expansion Attic ( ) Garbage Grinder (,vo) DwellingNo. of Bedrooms_____________"3.........................__ aOther—Type of Building ----------------------_--- No. of persons..-_------.._------_--_----- Showers ( ) — Cafeteria ( ) aOther fixtures ..... ..................... .......................... W Design Flow-----------------V-9---------------------gallons per person per day. Total daily flow.............3.Q-9.._.................`..gallons. WSeptic Tank-1-Liquid capacityho_A o._gallons Length--____-9-------- Width_---I......... Diameter__-_.4--------- Depth.---! ------- x Disposal Trench—No. .................... Width.................... Total Length-.---..-_-_-__---. Total leaching area........------ -----sq. ft. Seepage Pit No........./........... Diameter.......4........... Depth below inlet......d_............ Total leaching area__/o_e..;'.__--sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date....._.....__/��--7- - Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water-----------......-..---- 4q Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--------------.-----.--- - -------------------------------------- -- ------- ----------------------- Description of Soil-- -..........Q`'•---- .. ...; � �r � �.. �1_. . ,� V--------------------------------------- _.-, = W ---------- �-..�../ ' -- f ------------------------------------------------------------------------- VNature of Repairs or Alterations—Answer when applicabl'e.-._-_...................................................................................:...... ------------------------------------- ----------- -----•----.......... ..............................................................----------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. igned-- --- ----- -- ° --------------------------------------------------` - ----- - -- ----------------------------- Date Application Approved By----------- --- ------ ---- --------------------------- ---------- Date Application Disapproved for the following reasons_______________________________ ------------------------------- -------------- .................................................................................................................................................................................................... Date PermitNo......................................................... Issued........................................................ Date / No.......... ..../.. .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH _L" /�'t..__....OF....... ............. .......... M .. ......... . . . . .... ............ Appliration -for M_gvoiittl. Works TowitrOrtioo Vantit Application is hereby`made for a Permit to Construct (V) or.Repair ( ) an Individual Sewage Disposal System at: ------ / Location-Address or Lot No. - _..__'..._f-__-'._> ....................... .... ._._ C/ x .__..___''�"'//1-Jy A 1/ •---° l-� I l".!:!.h!•.1.?..�`Vic_!_S f�. �------------- - 1-�---------------�!-5�--- f• S.............................. Owner Address W j� - Sl G I!!~0 S/ ' .......! _------•-- Installer Address UType of Building C A N 1 Size _...._.Sq. feet Dwelling—No. of Bedrooms-------------3_............................Expansion Attic ( ) Garbage Grinder (Aio) aOther —Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures --•-------------•-----•••-•-•-------=-------------- --------------•--•---•-------- W Design Flow.................519.....................gallons per person per day. Total daily flow---- •--- .......................gallons. P4 Septic Tank-L Liquid capacitylo_9 u__gallons Length...... ....... Width-----5......... Diameter_-.-- ----- Depth_._t_/----_. xDisposal Trench—No..................... Width-------------------- Total Length.------------------- Total leaching area--------------------sq. ft. Seepage Pit No--------/--------_.. Diameter.......G----------- Depth below inlet...... ------------ Total leaching area-_lo_o o sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by---- ---_------------------ ---•-••--•-•---- Date--------------------------------------- Test Pit No. 1----------------minutes per inch Depth of "lest Pit____________________ Depth to ground water..-----__--.---"-.__-- (4 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ -------------------------- ----- -- -------------•-..--• ----•- f - V .....----•---.....-------•------- ... D Descript'on of Soil .. '�+--' 4h2� -- H_ "� ��'� _ -------------------------------------------------------- ----- --- � 1 ti-s- 4 -- -- - ---- ------ U Nature of Repairs or Alterations—Answer when applicable.----------------------------------- ----'_,:____________.._._.__.__........_____..._.___._._... -•••------••-------------- ------------------------- Agreement: :; t The.'undersigned agree's«to`install the•�aforedescribed Individual.Sewage Disposal System in accordance with the provisions of Article LI of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health.. tgned .......................... .•-•---•--.....---- -------------------------------- ------------ Application a Approved By `• Y .� ate " Date---------------------------------------- Application Disapproved for the following reasons:.................................................................................................................. r .:,.._....:: ------ -------------- Date PermitNo.. ....................................... Issued......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... ...................... (Irdif iratr of TOmplianrr TS Tp CERTIFY, That the Individual Sewage Disposal System constructed (Wj or Repaired ( ) ----- ----- ----•----------•-----------------------•---------------------------------------------------•---....---- 1 " Installer at----- -�-Jll.....1 I C�zh cu------ -L ..........................................................I tZ S has been installed in accordance with the provisions of A e XI of..The State Sanitary Code as described in the application for Disposal Works Construction Permit No�...e 2 dated....... _/.7" -f 7 THE.".ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GU RANT E THAT THE SYSTEM JI L FU•NCTIO SATISFACTORY. DATE----��-✓--�-/-----------�O-�_7------------------------------ Inspector--:------ ---------- 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH • i Y �.y ...... ......O F........ : � C ........................... No......------.. ......... FEE---/ ............. Bi-rupotial Norkii Cflomithirtion Prrmit Perriission is hereby granted------------------- `2'�� ��........................ -------------------------------------- .................................. to Constiuct­(�—) or. Repair`,( ) an Individual Sewage Disposal System atNo.- -t,'....... ........A:µ!N_K1.•..................•..------ t--'- r=y ---------------------------------------- ................... . � Street '� ' as shown on the application for Disposal Works Construction Per No _:__ __/_._ ___. Dated__'I 7_____________ J T`` Board of Heal DATE-------.--=---------------------------=•................-...................... • FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS p as { Vt " ° Zf /✓/ic A7Ztirxi�E ; ram, a`h: rs✓f / //✓'i�t / _ , je I HEREBY CERTIFY THAT Tti"r' ( P LAN OF I_ AND R STRUCTURE STRUCTURE SHOWN HEREON WAS LOCATED i BY AN ACTUAL FIELD SURVEY ON ON '• �,�i //�� 1977 AND CONFORMS '}Of. THE ZONING BY-LAW OF THE TOWN CF=i E,67' MASSACFIUSFT i S I MASS. REGISTERED. LAND SURVEYOR E I t�- aW r. �,1977 17 DATE �titNOF gss CAPE 'OD SURVEY CONSULTANTS �o DAMES A DIaiJ';ION OF QOSTON SURVEY CONSULTANTS, INC. ROUTE 132 w1swELu y HYANNI3, MASS. .p No. 11029 O TERyp �� SURF'